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More Data on Coronary Artery Stenting.
Two studies in this issue of The New England Journal of Medicine address important questions about coronary artery stenting. The first compared three regimens for stent thrombosis prevention: 1,653 patients with successfully placed coronary stents were randomized to receive aspirin alone, aspirin plus warfarin, or aspirin plus ticlopidine.
At 30 days, a composite endpoint reflecting stent thrombosis (death, revascularization of the target lesion, angiographic thrombosis, or myocardial infarction) was significantly less common with aspirin plus ticlopidine (0.5 percent) than with aspirin plus warfarin (2.7 percent) or aspirin alone (3.6 percent). However, the aspirin/ticlopidine group had a higher rate of hemorrhagic complications than the group using aspirin alone (5.5 percent vs. 1.8 percent).
The second study compared two approaches to patients who had restenosis of a coronary lesion previously treated successfully by balloon angioplasty (PTCA): 383 such patients were randomized to PTCA alone or PTCA with stenting. Compared with the PTCA-only group, the stent group had significantly lower rates of angiographic restenosis (32 percent vs. 18 percent) and revascularization of the target lesion (27 percent vs. 10 percent) at six-month follow-up. However, subacute thrombosis and bleeding complications were more common with stenting.
Comment: The combination of two antiplatelet drugs -- ticlopidine and aspirin -- results in the lowest rate of stent thrombosis but increases the risk for bleeding. And in patients with restenosis after a successful PTCA, stenting appears to improve six-month outcomes compared with repeating the PTCA only. However, an editorialist expresses concern that the procedure may be overused in the U.S.
— AS Brett
Published in Journal Watch General Medicine December 15, 1998
Citation(s):
Leon MB et al. A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. N Engl J Med 1998 Dec 3 339 1665-1671.
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Erbel R et al. Coronary-artery stenting compared with balloon angioplasty for restenosis after initial balloon angioplasty. N Engl J Med 1998 Dec 3 339 1672-1678.
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Topol EJ. Coronary-artery stents -- gauging, gorging, and gouging. N Engl J Med 1998 Dec 3 339 1702-1704.
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